Presentation
Fevers, night sweats and weight loss. Known HIV positive with CD4 count 25 cells/mm3.
Patient Data
Multifocal bilateral patchy areas of ground-glass opacity involving all lobes.
Small pneumatocoele with multiple septae in the right lower lobe.
The findings are consistent with atypical pulmonary infection, most likely pneumocystis jirovecii given the history and imaging features.
Case Discussion
This case demonstrates the classic ground-glass multifocal densities seen in pulmonary pneumocystis jirovecii (PJP) infection, predominantly involving the mid-zones.
In addition there is a small pneumatocoele which can also be a feature.
The disease invariably affects patients who are immunocompromised and, in the case of those infected with HIV, typically occurs at CD4 count < 200 cells/mm3.
Pulmonary PJP is an AIDS defining illness.
Case with thanks to Dr Matthew Lukies.
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